Fields of treatment / Gynecology / Ultrasound diagnostics
Ultrasound diagnostics
Examination of the internal female genital organs (uterus, ovaries and fallopian tubes) and the entire small pelvic area. It is usually performed using a vaginal ultrasound probe, which is inserted into the vagina. The examination is neither painful nor dangerous. It is best performed when the urinary bladder is empty.
As the examination progresses, the doctor talks to the client about what he/she sees and the client is always informed of the result at the end.
Ultrasound examination at 6 - 10 weeks of pregnancy
The aim of this ultrasound examination is to confirm the pregnancy by detecting the gestational sac with embryonic structures inside the uterus.
The number of gestational sacs and embryos is determined. At the same time, a dating scan is carried out, i.e. estimated due date is calculated as the size of the gestational sac and embryo are measured. This method of calculating due date is more accurate than due date being calculated from the date of the last menstrual period.
At this stage of pregnancy, the examination is carried out with a vaginal probe through the vagina, preferably with an empty bladder.
This examination is also advised for pregnant women who experienced bleeding, lower abdominal pain or other problems in which the ultrasound can rule out miscarriage or a pregnancy that happens outside the uterus.
Ultrasound examination at 11-14 weeks of pregnancy
This stage of pregnancy is the ideal time for combined screening for Down syndrome.
This screening consists of two parts (hence the name combined screening) - a biochemical examination of maternal blood and an ultrasound evaluation of the presence of certain features (markers) measured on the fetus. From the values obtained, the risk of fetus having certain conditions can be assessed.
First trimester screening for Down syndrome uses the following to determine the risk of the fetus having certain birth defects:
- the age of the mother
- the age of the fetus
- the levels of two substances in the blood of the pregnant women (ß-hCG & PAPP-A)
- nuchal translucency at the are at the back of the fetal neck (measurement of amount of fluid behind your baby’s neck)
- the presence or absence of a fetal nasal ossicle
- normal or abnormal flow at the tricuspid valve in the fetal heart
- normal or abnormal flow in the ductus venosus
First trimester combined screening and maternal blood test has a 90% success rate in determining if the fetus might have a birth defect. It is much more accurate than the biochemical screening (known as triple test) performed at 16 weeks of pregnancy. For this reason, it is nowadays recommended to replace the triple test with a first trimester combined screening.
After the ultrasound examination, the risk of occurrence of Down syndrome in the fetus is calculated using special software. The result of the test is explained to the patient in a detailed and understandable way. If the screening is abnormal, various options to address it are discussed.
However, to confirm a suspected occurrence of Down syndrome, cytogenetic testing of the placenta (known as chorionic villus sampling) or amniotic fluid (genetic amniocentesis) is necessary. Because the sampling involves the insertion of a needle into the uterus, these procedures are referred to as invasive. These samplings are performed under ultrasound guidance and are highly safe when performed by an experienced physician. The risk of miscarriage after this invasive test is reported to be only between 0.5-1% and is always lower than the risk of giving birth to an affected foetus.
If a pregnant woman chooses to have an invasive procedure (CVS - chorionic villus sampling), it can usually be performed in a few days after a genetic consultation. The first results are known within 48 hours after sampling.
As G-med follows the guidelines of the Fetal Medicine Foundation, London (www.fetalmedicine.com), it offers Down syndrome screening at 11-14 week of pregnancy, which is performed by FMF certified specialists. In our clinic, these invasive procedures are performed by an experienced FMF-certified physician, MUDr. Jaroslav Galát.
The list of FMF-certified physicians who are annually audited can be viewed at: https://courses.fetalmedicine.com/lists/specialist
Ultrasound examination at 20 – 22 weeks of pregnancy
The aim of the ultrasound examination at 20 - 22 weeks of pregnancy is to examine in detail all fetal body parts and to look for possible birth defects. A detailed examination can detect around 90% of serious structural defects in the fetus. The success of detecting congenital defects depends, of course, on the experience of the ultrasound technician, the quality of the ultrasound machine and the quality of the imaging related to the mother's physical constitution (obesity, scars, etc.).
In addition to assessing the development of the organs, this examination also includes a check of the placenta, fetal growth and the amount of amniotic fluid.
Ultrasound examination at 30-32 weeks of pregnancy
The main purpose of this ultrasound examination is to measure fetal growth, amniotic fluid amount, check placental position and structure. At the same time, the basic anatomy of the fetus is checked.
If insufficient fetal growth is detected, the examination should be immediately followed by Doppler ultrasound measurement of the blood circulation in the baby and mother. The result of this follow-up examination will give more information about the current condition of the fetus and if the fetus is at risk for a placental failure, which leads to insufficient supply of oxygen and nutrients to the fetus.
